What about the best analgesic used in post transplant period?
We usually use perfelgan but sometimes, it does not work.
Ahmed Fouad Omar
2 years ago
Thank you for thr excellent lecture
Hussam Juda
2 years ago
Thank you
Hinda Hassan
2 years ago
Thank you for the nice lecture
Marius Badal
2 years ago
thank you. very imformative
Manal Malik
2 years ago
Thanks excellent informative lecture
Mohamed Essmat
2 years ago
Thank you Professor
Nahla Allam
2 years ago
thank you for nice informative lectuer
Mohamed Ghanem
2 years ago
Many thanks prof for this lecture
AMAL Anan
2 years ago
Thanks for presenting and highly rich informative one
Dalia Ali
2 years ago
Thanks for nice presentation
Wael Jebur
2 years ago
It was a deep and informative lecture , Thanks alot
KAMAL ELGORASHI
2 years ago
Thank you prof. for this valuable and informing presentation
Abdullah Raoof
2 years ago
Thank you Prof Ahmed halawa for this informative lecture.
Mahmoud Wadi
2 years ago
I would ask our Prof. Halawa about analgia postoperative pain after renal transplant may be severe, but administration of systemic analgesia may be limited due to impaired renal function and respiratory complications.
thank you very much Prof.Halawa
Mahmoud Wadi
2 years ago
Thank you Prof Ahmed Halawa for nice lecture!
My Question!
What the best do bilateral nephrectomy or denervation prior to transplant in hemodialysis patient with RH to medical treatment ?
Ahmed Omran
2 years ago
very clear and comprehensive presentation
Osama Hendam
2 years ago
Very informative lecture, thanks alot
Mahmoud Hamada
2 years ago
Thanks for the informative lecture.
Giulio Podda
2 years ago
Very useful and clear lecture. Thanks
Shashi Naveen
2 years ago
thank you for such a extensive detailed talk prof Halawa. had a great learning about the cardiac assessment of CKD patients.
Mohamed Saad
2 years ago
Thanks for this great lecture
MILIND DEKATE
2 years ago
thank you sir
for much informative lecture
Alaa eddin salamah
2 years ago
Thank you Professor Halwa for this sharp start of a new module.
It is a comprehensive revision!
Maksuda Begum
2 years ago
Dear Sir
Thank you so much for the concise informative lecture.
Sameh Arman
2 years ago
Thank you dr Ahamad very informative and focused lecture. and very good for me as first time to study renal transplantation
Eusha Ansary
2 years ago
Very insightful lecture regarding cardiac evaluation before renal transplant surgery. Though some confusions still in my mind specially regarding coronary angiogram and surgical or percutaneuos intervention in ESRD patients .
Anna Gupta
2 years ago
Thank you so much for a very wonderful lecture. So what should be done in diabetics with Symptoms if invasive angiogram is not helpful?
Mohamed Essmat
2 years ago
Good afternoon Prof. , Thank you so much for the concise informative lecture , the cardiac issue is indeed a point that should always be triggered , pre assessment and post follow up , kindly what are the indications of anti-platelets post Tx , and when shall they start ?
Is it indicated to close the AVF post Tx in heart failure individuals or post Tx ?
Do all diabetics will undergo MPI , regardless of the age ? Or Other risk factors ?
Thank you prof.
Last edited 2 years ago by Mohamed Essmat
Mahmoud Rabie
2 years ago
Thank you so much Prof Ahmed for this great lecture.
Dalia Ali
2 years ago
Thanks for this informative lecture
Amna Khalifa
2 years ago
do you consider a patient with bronchiectasis as contraindication for kidney transplant?
Mahmoud Wadi
2 years ago
thank you ,Prof.dr.Ahmmed for you underfulland intersting lecture
Thank you, Professor, for this comprehensive and interesting lecture
Walaa Elhakeem
2 years ago
MANY THANKS FOR YOU PROFESSOR AHMED FOR YOUR WOUNDERFUL LECTURE
Nashwa salah Mahmoud Ahmed
2 years ago
Alot of Thanks professor for the informative lecture.
Hinda Hassan
2 years ago
Thank you Prof.Ahmed for the informative lecture as usual.
Mu'taz Saleh
2 years ago
Thank You Prof DR Ahmed to this great effort and nice lecture , really it is very useful
Mahmud Islam
2 years ago
Thank you, Prof.Dr.Ahmed for this concise and precise summarizing lecture. I want to ask whether you practice and ask for tests yourself or do it as a cardiology preoperative evaluation (as routine). in other words do you leave decision of cardiac evaluation to a cardiologist who will plan the suitable tests himself?
Fatima AlTaher
2 years ago
Thanks alot for this informative lecture, prof Halawa.but what about idiopathic dilated cardiomyopathy .we have a 23y old male patient, manual worker, ESRD (unknown etiology) on RHD for 5months only , normotensive , not diabetic. Echo revealed DCM e EF 42% not of ischemic or rheumatic . immune work up (ANS, C3,C4, ANCA) negative, TSH , S ferritin, S amyloid with in normal levels. ECG no ischemic changes . CT coronary angio
Normal .MRI cardio just DCM without any infiltrate , ischemia.Functionally , perfect he can climb 5 floors without dyspnea. So do we need any further investigations? And what precautions to be taken in post transplant period other than meticulous fluid therapy?
any family history of CKD , premature stroke and death in the family , consider Fabry disease as one of DDX in his case
Yashu Saini
2 years ago
Thanks a lot, Prof Halawa for the nice informative lecture.
But I would like to comment that being a pediatric nephrologist, all this about pre transplant cardiac evaluation was totally new for me.
In pediatric CKD patients, Hypertension and Hyperphosphetemia are the two most important factors which are the independent markers of cardiac morbidity in pediatric CKD population heading for transplant.
Between these two factors we face hurdles most because of hypertension.
We all know that pediatric hypertension is bit more tricky to manage as compared to adults. Almost more than 80% of Pediatric CKDs have hypertension.
As a part of cardiac evaluation in pediatric ckd patients prior to transplant we limit ourselves to ECG and ECHO and by these 2 investigations we evaluate patients for congenital major vascular malformations (aortic aneurysms, etc.), rhythm disturbances and other cardiac anomalies secondary to hypertension.
Proteinuria CKDs (congenital nephrotic syndrome, FSGS, HUS, C3 glomerulopathies, etc) are worst affected by hypertension.
So as pediatric nephrologists we come across hypertension associated cardiac abnormalities at majority of times.
Thank you Prof Ahmed Halawa for nice lecture!
My Question! is there any chance to do bilateral nephrectomy prior to transplant in haemodialysis patient with refractory hypertension to medical treatment ?
At our centre our surgeons defer the nephrectomy to after transplant as during the ureic period there is ureic coagulopathy which results in more bleeding and also prolonged ileus which is morbid and at times fatal. so a decision for pretransplant nephrectomy is like double edged sword.
Mohammed Sobair
2 years ago
Thank Prof. Halawa for nice lecture.
Recurrent renal disease as contraindication if cause more than 2 rejection ,if am not
mistaken.
Your hospital protocol put Diabetes patient for angiogram only if symptomatic or with
Abnormal MPI ,do this protocol shows any different for risk stratification of diabetes
patient ,compared to CAT for all diabetes patient ,more than 50 years as suggested by
I will advice you look for possible secondary cause of hypertension like endocrine causes to renal artery stenosis.
I also want to believe you have use the maximum dose of the antihypertensives with a diuretic inclusive and be sure the patient is adherent on medication
We need to make sure about hypervolemia; kindnely remember that even KTI may be normal with no pretibial edema even in the presence of 3-5 KG(L). you can see that often and you see that the interdialytic weight of some patients is 4-5 kg but you do not see obvious edema or effusion
Also, notice that telecardyogram may not show you pleural effusion although you can confirm 3-4 cm of the fluid level while in the supine position using the CHEST spiral tomography.
in case yo dry the patient as we may see a percentage of patients are still hypervolemic you proceed to second causes
bu remember that we need to suppress aldostesterone/sympathetic activity son first choice is ACEI or ARB, paying attention to hyperkalemia.. we do usually prefer CCB blokers but alkk ckd patients need ACEI/ARB as the first choice
do remember that CKD even in the early stage is a secondary cause of HT
of course, still any other causes applicable for the general population is a probability and may accompany essential HT .. (usually, a secondary cause will cause abrup deterşoration in contrast to previously notes: just review the patients’ records to make sure)
Mahmoud Wadi
2 years ago
Thank you Prof.dr.Ahmed for this wonderful and interesting lecture .
I would like to ask you WHAT about hypertensive pateint and treated only monotherapy and his PB control.
IS he allowed to donate?
thanks.
Thank u dr.
Waiting the pedatric nephrology webinar on 23/09/22
MICHAEL Farag
2 years ago
thanks for this excellent lecture
waiting for part 2
Ramy Elshahat
2 years ago
thanks for excellent presentation
my question regarding evaluation of blood perfusion on the capillary and small blood vessels level
is it needed or only what needed is excluding lesion at large coronary vessels level.
What about the best analgesic used in post transplant period?
We usually use perfelgan but sometimes, it does not work.
Thank you for thr excellent lecture
Thank you
Thank you for the nice lecture
thank you. very imformative
Thanks excellent informative lecture
Thank you Professor
thank you for nice informative lectuer
Many thanks prof for this lecture
Thanks for presenting and highly rich informative one
Thanks for nice presentation
It was a deep and informative lecture , Thanks alot
Thank you prof. for this valuable and informing presentation
Thank you Prof Ahmed halawa for this informative lecture.
I would ask our Prof. Halawa about analgia postoperative pain after renal transplant may be severe, but administration of systemic analgesia may be limited due to impaired renal function and respiratory complications.
thank you very much Prof.Halawa
Thank you Prof Ahmed Halawa for nice lecture!
My Question!
What the best do bilateral nephrectomy or denervation prior to transplant in hemodialysis patient with RH to medical treatment ?
very clear and comprehensive presentation
Very informative lecture, thanks alot
Thanks for the informative lecture.
Very useful and clear lecture. Thanks
thank you for such a extensive detailed talk prof Halawa. had a great learning about the cardiac assessment of CKD patients.
Thanks for this great lecture
thank you sir
for much informative lecture
Thank you Professor Halwa for this sharp start of a new module.
It is a comprehensive revision!
Dear Sir
Thank you so much for the concise informative lecture.
Thank you dr Ahamad very informative and focused lecture. and very good for me as first time to study renal transplantation
Very insightful lecture regarding cardiac evaluation before renal transplant surgery. Though some confusions still in my mind specially regarding coronary angiogram and surgical or percutaneuos intervention in ESRD patients .
Thank you so much for a very wonderful lecture. So what should be done in diabetics with Symptoms if invasive angiogram is not helpful?
Good afternoon Prof. , Thank you so much for the concise informative lecture , the cardiac issue is indeed a point that should always be triggered , pre assessment and post follow up , kindly what are the indications of anti-platelets post Tx , and when shall they start ?
Is it indicated to close the AVF post Tx in heart failure individuals or post Tx ?
Do all diabetics will undergo MPI , regardless of the age ? Or Other risk factors ?
Thank you prof.
Thank you so much Prof Ahmed for this great lecture.
Thanks for this informative lecture
do you consider a patient with bronchiectasis as contraindication for kidney transplant?
thank you ,Prof.dr.Ahmmed for you underfulland intersting lecture
Thanks our prof for this nice lecture
Thank you, Professor, for this comprehensive and interesting lecture
MANY THANKS FOR YOU PROFESSOR AHMED FOR YOUR WOUNDERFUL LECTURE
Alot of Thanks professor for the informative lecture.
Thank you Prof.Ahmed for the informative lecture as usual.
Thank You Prof DR Ahmed to this great effort and nice lecture , really it is very useful
Thank you, Prof.Dr.Ahmed for this concise and precise summarizing lecture. I want to ask whether you practice and ask for tests yourself or do it as a cardiology preoperative evaluation (as routine). in other words do you leave decision of cardiac evaluation to a cardiologist who will plan the suitable tests himself?
Thanks alot for this informative lecture, prof Halawa.but what about idiopathic dilated cardiomyopathy .we have a 23y old male patient, manual worker, ESRD (unknown etiology) on RHD for 5months only , normotensive , not diabetic. Echo revealed DCM e EF 42% not of ischemic or rheumatic . immune work up (ANS, C3,C4, ANCA) negative, TSH , S ferritin, S amyloid with in normal levels. ECG no ischemic changes . CT coronary angio
Normal .MRI cardio just DCM without any infiltrate , ischemia.Functionally , perfect he can climb 5 floors without dyspnea. So do we need any further investigations? And what precautions to be taken in post transplant period other than meticulous fluid therapy?
any family history of CKD , premature stroke and death in the family , consider Fabry disease as one of DDX in his case
Thanks a lot, Prof Halawa for the nice informative lecture.
But I would like to comment that being a pediatric nephrologist, all this about pre transplant cardiac evaluation was totally new for me.
In pediatric CKD patients, Hypertension and Hyperphosphetemia are the two most important factors which are the independent markers of cardiac morbidity in pediatric CKD population heading for transplant.
Between these two factors we face hurdles most because of hypertension.
We all know that pediatric hypertension is bit more tricky to manage as compared to adults. Almost more than 80% of Pediatric CKDs have hypertension.
As a part of cardiac evaluation in pediatric ckd patients prior to transplant we limit ourselves to ECG and ECHO and by these 2 investigations we evaluate patients for congenital major vascular malformations (aortic aneurysms, etc.), rhythm disturbances and other cardiac anomalies secondary to hypertension.
Proteinuria CKDs (congenital nephrotic syndrome, FSGS, HUS, C3 glomerulopathies, etc) are worst affected by hypertension.
So as pediatric nephrologists we come across hypertension associated cardiac abnormalities at majority of times.
Thanks
Thank you for Yashu
Thank you Prof Ahmed for the lecture & the great effort from all professors & colleagues
Thank you
Thank you Prof Ahmed Halawa for nice lecture!
My Question!
is there any chance to do bilateral nephrectomy prior to transplant in haemodialysis patient with refractory hypertension to medical treatment ?
Thank you, Sahar
The is a role but of doubtful significance. By the time we do bilateral nephrectomy, other mechanisms have taken over (too late).
At our centre our surgeons defer the nephrectomy to after transplant as during the ureic period there is ureic coagulopathy which results in more bleeding and also prolonged ileus which is morbid and at times fatal. so a decision for pretransplant nephrectomy is like double edged sword.
Thank Prof. Halawa for nice lecture.
Recurrent renal disease as contraindication if cause more than 2 rejection ,if am not
mistaken.
Your hospital protocol put Diabetes patient for angiogram only if symptomatic or with
Abnormal MPI ,do this protocol shows any different for risk stratification of diabetes
patient ,compared to CAT for all diabetes patient ,more than 50 years as suggested by
AAC and KDIQO.(also in our center ).
Thank you Dr Mohamed
All diabetic will have MPI first, if shows reversible ischaemia, then CA
What the best option mangement resistant hypertensive pateint on regulare hemodialysis if he not cadidate to kidney transplantion ?
Thanks
I will advice you look for possible secondary cause of hypertension like endocrine causes to renal artery stenosis.
I also want to believe you have use the maximum dose of the antihypertensives with a diuretic inclusive and be sure the patient is adherent on medication
Thank you BOTH
We need to make sure about hypervolemia; kindnely remember that even KTI may be normal with no pretibial edema even in the presence of 3-5 KG(L). you can see that often and you see that the interdialytic weight of some patients is 4-5 kg but you do not see obvious edema or effusion
Also, notice that telecardyogram may not show you pleural effusion although you can confirm 3-4 cm of the fluid level while in the supine position using the CHEST spiral tomography.
in case yo dry the patient as we may see a percentage of patients are still hypervolemic you proceed to second causes
bu remember that we need to suppress aldostesterone/sympathetic activity son first choice is ACEI or ARB, paying attention to hyperkalemia.. we do usually prefer CCB blokers but alkk ckd patients need ACEI/ARB as the first choice
do remember that CKD even in the early stage is a secondary cause of HT
of course, still any other causes applicable for the general population is a probability and may accompany essential HT .. (usually, a secondary cause will cause abrup deterşoration in contrast to previously notes: just review the patients’ records to make sure)
Thank you Prof.dr.Ahmed for this wonderful and interesting lecture .
I would like to ask you WHAT about hypertensive pateint and treated only monotherapy and his PB control.
IS he allowed to donate?
thanks.
Yes, provided that there is no end organ damage
Thank you alot our Prof.Ahmed Halawa
Thank you for this valuable lecture.
Thank u dr.
Waiting the pedatric nephrology webinar on 23/09/22
thanks for this excellent lecture
waiting for part 2
thanks for excellent presentation
my question regarding evaluation of blood perfusion on the capillary and small blood vessels level
is it needed or only what needed is excluding lesion at large coronary vessels level.
Thank you, Rami; MPI is of moderate sensitivity in CKD. It assesses the perfusion holistically.
thanks professor Halawa